This 72YO female presented with 7 months of stable decreased vision in her left eye. Vision was 20/20 OD and 20/30 OS.
Pseudocolor SLO imaging shows irregular foveal pigment loss with more distal drusen-like changes. There is diffuse outer nuclear layer macular schisis on OCT. An optic pit is noted along the temporal edge of the nerve, which directly communicates with the schisis cavity. Observation was recommended.
Learning Points:
An optic nerve pit is a rare (about 0.1% prevalence) congenital anomaly thought to be caused by incomplete closure of the optic fissure during gestation. Pits are most often located within or along the inferior-temporal disc margin and usually appear as a gray depression. While most optic pits are asymptomatic, they can cause vision loss by forcing fluid into the inner retina, outer retina, and, ultimately, the subretinal space (optic pit maculopathy). The source of the fluid remains a subject of ongoing debate, with opinions ranging from the vitreous to the subarachnoid space.
